tbuckley/cabot-search huggingface dataset:
Psychiatrists call for better workplace support for people with mental health problems
Authors: Adele Waters
Journal: BMJ (2022)

Investors who believe an active manager has insights or forecasts with the potential to earn higher relative returns may look for the manager to concentrate their portfolios. Because foresight is imperfect and correct forecasts will lead to more favorable outcomes and incorrect forecasts to less favorable outcomes, this analysis seeks to explore the impact of decisions to increase concentration on performance. We used portfolio sorts, standard OLS regression methods, and quantile regression methods to test the effect of portfolio concentration in various ways. We found that concentration has a significant convex relationship with the absolute value of relative returns. That is, as the effective number of holdings increases, its association with positive and negative relative performance diminishes. Additionally, we find that increasing concentration has a pronounced positive impact on performance for outperforming funds; the opposite is true for underperforming funds. Most importantly, higher levels of concentration generally hurt the poorly performing funds more than it helps the outperforming funds. For investors and gatekeepers who focus on holdings-based measures of concentration, the findings show that you can’t just look at holdings-based measures of concentration without considering industry exposures.
An inactivated multivalent influenza A virus vaccine is broadly protective in mice and ferrets
Authors: Jaekeun Park, Sharon L. Fong Legaspi, Louis M. Schwartzman, Sebastian M. Gygli, Zhong-Mei Sheng, Ashley D. Freeman, Lex M. Matthews, Yongli Xiao, Mitchell D. Ramuta, Natalia A. Batchenkova, Li Qi, Luz Angela Rosas, Stephanie L. Williams, Kelsey Scherler, Monica Gouzoulis, Ian Bellayr, David M. Morens, Kathie-Anne Walters, Matthew J. Memoli, John C. Kash, Jeffery K. Taubenberger
Journal: Science Translational Medicine (2022)

Influenza A viruses (IAVs) present major public health threats from annual seasonal epidemics and pandemics and from viruses adapted to a variety of animals including poultry, pigs, and horses. Vaccines that broadly protect against all such IAVs, so-called “universal” influenza vaccines, do not currently exist but are urgently needed. Here, we demonstrated that an inactivated, multivalent whole-virus vaccine, delivered intramuscularly or intranasally, was broadly protective against challenges with multiple IAV hemagglutinin and neuraminidase subtypes in both mice and ferrets. The vaccine is composed of four β-propiolactone–inactivated low-pathogenicity avian IAV subtypes of H1N9, H3N8, H5N1, and H7N3. Vaccinated mice and ferrets demonstrated substantial protection against a variety of IAVs, including the 1918 H1N1 strain, the highly pathogenic avian H5N8 strain, and H7N9. We also observed protection against challenge with antigenically variable and heterosubtypic avian, swine, and human viruses. Compared to control animals, vaccinated mice and ferrets demonstrated marked reductions in viral titers, lung pathology, and host inflammatory responses. This vaccine approach indicates the feasibility of eliciting broad, heterosubtypic IAV protection and identifies a promising candidate for influenza vaccine clinical development.
Microenvironment-tailored micelles restrain carcinoma-astrocyte crosstalk for brain metastasis
Authors: Zhenhao Zhao, Yujie Zhang, Chao Li, Xuwen Li, Yongchao Chu, Qin Guo, Yiwen Zhang, Weiyi Xia, Peixin Liu, Hongyi Chen, Yu Wang, Chufeng Li, Tao Sun, Chen Jiang
Journal: Journal of Controlled Release (2022)
Associations between long-term exposure to wildfire-related particulate matter and site-specific cancer mortality: a national study in Brazil, 2010–16
Authors: Pei Yu, Rongbin Xu, Shanshan Li, Xu Yue, Gongbo Chen, Tingting Ye, Micheline Coêlho, Paulo Saldiva, Malcolm R Sim, Michael J Abramson, Yuming Guo
Journal: The Lancet Oncology (2022)
Feasibility of human papillomavirus self-sampling to combat COVID-19-related disruptions to cervical cancer screening: a cross-sectional survey
Authors: Eliza Lai-Yi Wong, Candy Ngai-Sze Wong, Annie Wai-Ling Cheung, Amy Yuen-Kwan Wong, Zoe Pui-Yee Tam
Journal: The Lancet Oncology (2022)
The first international Delphi consensus statement on Laparoscopic Gastrointestinal surgery
Authors: Islam Omar, Karl Miller, Brijesh Madhok, Bassem Amr, Rishi Singhal, Yitka Graham, Sjaak Pouwels, Mohammad Abu Hilal, Sandeep Aggarwal, Irfan Ahmed, Ali Aminian, Basil Jaser Ammori, Tan Arulampalam, Altaf Awan, José María Balibrea, Aneel Bhangu, Richard Raymond Brady, Wendy Brown, Manish Chand, Ara Darzi, Talvinder Singh Gill, Ramen Goel, Bussa R. Gopinath, Mark van Berge Henegouwen, Jacques M. Himpens, David Daniel Kerrigan, Misha Luyer, Christian Macutkiewicz, Julio Mayol, Sanjay Purkayastha, Raul Jacobo Rosenthal, Scott Alan Shikora, Peter Kenneth Small, Neil James Smart, Mark A. Taylor, Tehemton E. Udwadia, Tim Underwood, Yirupaiahgari KS. Viswanath, Neil Thomas Welch, Steven D. Wexner, Michael Samuel James Wilson, Des C. Winter, Kamal K. Mahawar
Journal: International Journal of Surgery (2022)
Drug independence and the curability of cancer by combination chemotherapy
Authors: Amy E. Pomeroy, Emmett V. Schmidt, Peter K. Sorger, Adam C. Palmer
Journal: Trends in cancer (2022)

Combination chemotherapy can cure certain leukemias and lymphomas, but most solid cancers are only curable at early stages. We review quantitative principles that explain the benefits of combining independently active cancer therapies in both settings. Understanding the mechanistic principles underlying curative treatments, including those developed many decades ago, is valuable for improving future combination therapies. We discuss contemporary evidence for long-established but currently neglected ideas of how combination therapy overcomes tumor heterogeneity. We show that a unified model of interpatient and intratumor heterogeneity describes historical progress in the treatment of pediatric acute lymphocytic leukemia (ALL), in which increasingly intensive combination regimens ultimately achieved high cure rates. We also describe three distinct aspects of drug independence that apply at different biological scales. The ability of these principles to quantitatively explain curative regimens suggests that supra-additive (synergistic) drug interactions are not required for successful combination therapy.
Targeting CD22 on memory B cells to induce tolerance to peanut allergens
Authors: LaKeya C. Hardy, Johanna M. Smeekens, Dharmendra Raghuwanshi, Susmita Sarkar, Gour C. Daskhan, Stephen Rogers, Corwin Nycholat, Soheila Maleki, A. Wesley Burks, James C. Paulson, Matthew S. Macauley, Michael D. Kulis
Journal: Journal of Allergy and Clinical Immunology (2022)
Defining availability of 100 essential diagnostic items for children with cancer and gaps in implementing WHO recommendations: Global CEDx Working Group survey
Authors: Catherine G Lam, Ana Patricia Alcasabas, Federico Antillon, Patricia Calderon, Mae Dolendo, Ligia Fu, Yessika Gamboa, Pascale Gassant, Wendy Gomez-Garcia, Sanjeeva Gunasekera, Aye Aye Khaing, Roman Kizyma, Laila Hessissen, Justin Mulindwa, Yuliya Nogovitsyna, Claudia Pascual, Karina Quintero, Lorna Renner, Gabriela Soto, Liliana Vasquez, Roberto Vasquez, Monika Metzger
Journal: The Lancet Oncology (2022)
Transcatheter Mitral Valve Repair in Patients With Atrial Functional Mitral Regurgitation
Authors: Philipp Doldi, Lukas Stolz, Mathias Orban, Nicole Karam, Fabien Praz, Daniel Kalbacher, Edith Lubos, Daniel Braun, Marianna Adamo, Cristina Giannini, Bruno Melica, Michael Näbauer, Satoshi Higuchi, Mirjam Wild, Michael Neuss, Christian Butter, Mohammad Kassar, Aniela Petrescu, Roman Pfister, Christos Iliadis, Matthias Unterhuber, Holger Thiele, Stephan Baldus, Ralph Stephan von Bardeleben, Niklas Schofer, Christian Hagl, Anna Sonia Petronio, Steffen Massberg, Stephan Windecker, Philipp Lurz, Marco Metra, Jörg Hausleiter
Journal: JACC. Cardiovascular imaging (2022)
Kerala Cancer Control Strategy 2018–30: a pragmatic vision of equitable, accessible, and affordable cancer care in low-resource settings
Authors: Rajan N Khobragade, Mohammed Y Safirulla, Satheesan Balasubramanian, Rekha A Nair, Prabhakar Gouri Balagopal, Thayilekandy Ajayakumar, Suresh Kumar Kuttappan, Mahadevan Rajagopalapillai, Sajeev George Pulickal, Mathews Numpeli
Journal: The Lancet Oncology (2022)
Angiotensin II induces reactive oxygen species, DNA damage, and T-cell apoptosis in severe COVID-19
Authors: Lucy Kundura, Sandrine Gimenez, Renaud Cezar, Sonia André, Mehwish Younas, Yea-Lih Lin, Pierre Portalès, Claire Lozano, Charlotte Boulle, Jacques Reynes, Thierry Vincent, Clément Mettling, Philippe Pasero, Laurent Muller, Jean-Yves Lefrant, Claire Roger, Pierre-Géraud Claret, Sandra Duvnjak, Paul Loubet, Albert Sotto, Tu-Anh Tran, Jérôme Estaquier, Pierre Corbeau
Journal: Journal of Allergy and Clinical Immunology (2022)
Aberrant circulating tumour DNA methylations as biomarkers for early detection of pancreatic ductal adenocarcinoma: a retrospective study
Authors: Shiwei Guo, Mingyang Su, Chengcheng Ma, Xiaohan Shi, Minjie Xu, Suizhi Gao, Huan Wang, Yaqi Pan, Qiye He, Zhixi Su, Gang Jin
Journal: The Lancet Oncology (2022)
Exhaled SARS-CoV-2 RNA viral load kinetics measured by facemask sampling associates with household transmission
Authors: Daniel Pan, Caroline M. Williams, Jonathan Decker, Eve Fletcher, Shirley Sze, Sara Assadi, Richard Haigh, Baber Saleem, Joshua Nazareth, Natalie J. Garton, Manish Pareek, Michael R. Barer
Journal: Clinical Microbiology and Infection (2022)

No studies have examined longitudinal patterns of naturally exhaled SARS-CoV-2 RNA viral load (VL) during acute infection. We report this using facemask sampling (FMS) and assessed the relationship between emitted RNA VL and household transmission.Between December 2020 and February 2021, we recruited participants within 24 hours of a positive RT-qPCR on upper respiratory tract sampling (URTS) (day 0). Participants gave FMS (for 1 hour) and URTS (self-taken) on seven occasions up to day 21. Samples were analysed by RT-qPCR (from sampling matrix strips within the mask) and symptom diaries were recorded. Household transmission was assessed through reporting of positive URTS RT-qPCR in household contacts.Analysis of 203 FMS and 190 URTS from 34 participants showed that RNA VL peaked within the first 5 days following sampling. Concomitant URTS, FMS RNA VL, and symptom scores, however, were poorly correlated, but a higher severity of reported symptoms was associated with FMS positivity up to day 5. Of 28 participants who had household contacts, 12 (43%) reported transmission. Frequency of household transmission was associated with the highest (peak) FMS RNA VL obtained (negative genome copies/strip: 0% household transmission; 1 to 1000 copies/strip: 20%; 1001 to 10 000 copies/strip: 57%; >10 000 copies/strip: 75%; p = 0.048; age adjusted OR of household transmission per log increase in copies/strip: 4.97; 95% CI, 1.20-20.55; p = 0.02) but not observed with peak URTS RNA VL.Exhaled RNA VL measured by FMS is highest in early infection, can be positive in symptomatic patients with concomitantly negative URTS, and is strongly associated with household transmission.
AGILE 3+ Score for the Diagnosis of Advanced Fibrosis and for Predicting Liver-related Events in NAFLD
Authors: Grazia Pennisi, Marco Enea, Alessandra Pandolfo, Ciro Celsa, Michela Antonucci, Carlo Ciccioli, Giuseppe Infantino, Claudia La Mantia, Stefanie Parisi, Adele Tulone, Vito Di Marco, Antonio Craxì, Calogero Cammà, Salvatore Petta
Journal: Clinical Gastroenterology and Hepatology (2022)
Identifying areas at risk of endometrial cancer increase in Latin America: development of a geospatial model
Authors: Fernanda Guimarães de Sousa, Ana Beatriz Cordeiro Prates, Andrew Nogueira Albuquerque Leal, Larissa Batista Xavier, Diocésio Alves Pinto de Andrade, Angélica Nogueira-Rodrigues
Journal: The Lancet Oncology (2022)
Impact of meningococcal ACWY conjugate vaccines on pharyngeal carriage in adolescents: evidence for herd protection from the UK MenACWY programme
Authors: Jeremy P. Carr, Jenny M. MacLennan, Emma Plested, Holly B. Bratcher, Odile B. Harrison, Parvinder K. Aley, James E. Bray, Susana Camara, Charlene M.C. Rodrigues, Kimberly Davis, Angela Bartolf, David Baxter, J. Claire Cameron, Richard Cunningham, Saul N. Faust, Katy Fidler, Rohit Gowda, Paul T. Heath, Stephen Hughes, Sujata Khajuria, David Orr, Mala Raman, Andrew Smith, David P.J. Turner, Elizabeth Whittaker, Christopher J. Williams, Christos S. Zipitis, Andrew J. Pollard, Jennifer Oliver, Begonia Morales-Aza, Aiswarya Lekshmi, Stephen A. Clark, Ray Borrow, Hannah Christensen, Caroline Trotter, Adam Finn, Martin C. Maiden, Matthew D. Snape, Keith A. Jolley, Karen Ford, Hannah Roberts, Karen Palmer, Debbie Suggitt, Nicola Pemberton, Samantha Ray, Mandy Wootton, Shamez N. Ladhani, Daniel Owens, Katrina Cathie, Simon Royal, Neil Oldfield, Roisin Ure, Jennifer Richards, Rebecca Ramsay, Samantha Thomson Hill, Kaltun Duale
Journal: Clinical Microbiology and Infection (2022)

Serogroup W and Y invasive meningococcal disease increased globally from 2000 onwards. Responding to a rapid increase in serogroup W clonal complex 11 (W:cc11) invasive meningococcal disease, the UK replaced an adolescent booster dose of meningococcal C conjugate vaccine with quadrivalent MenACWY conjugate vaccine in 2015. By 2018, the vaccine coverage in the eligible school cohorts aged 14 to 19 years was 84%. We assessed the impact of the MenACWY vaccination programme on meningococcal carriage.An observational study of culture-defined oropharyngeal meningococcal carriage prevalence before and after the start of the MenACWY vaccination programme in UK school students, aged 15 to 19 years, using two cross-sectional studies: 2014 to 2015 "UKMenCar4" and 2018 "Be on the TEAM" (ISRCTN75858406).A total of 10 625 participants preimplementation and 13 438 postimplementation were included. Carriage of genogroups C, W, and Y (combined) decreased from 2.03 to 0.71% (OR 0.34 [95% CI 0.27-0.44], p < 0.001). Carriage of genogroup B meningococci did not change (1.26% vs 1.23% [95% CI 0.77-1.22], p = 0.80) and genogroup C remained rare (n = 7/10 625 vs 17/13 438, p = 0.135). The proportion of serogroup positive isolates (i.e. those expressing capsule) decreased for genogroup W by 53.8% (95% CI -5.0 - 79.8, p = 0.016) and for genogroup Y by 30.1% (95% CI 8.946·3, p = 0.0025).The UK MenACWY vaccination programme reduced carriage acquisition of genogroup and serogroup Y and W meningococci and sustained low levels of genogroup C carriage. These data support the use of quadrivalent MenACWY conjugate vaccine for indirect (herd) protection.
Feasibility of self-sampling and human papillomavirus testing in rural and urban areas for cervical cancer prevention in Bolivia: an observational study
Authors: Francesca Maria Carozzi, Ricardo Royder Yanez, Stefania Cannistrà, Marzia Matucci, Irene Paganini, Cristina Sani, Sandra Von Borries, Silvia Traina
Journal: The Lancet Oncology (2022)
Screening and eradication of Helicobacter pylori to prevent gastric cancer in indigenous Taiwanese communities: a population-based study and development of an index-case method
Authors: Wei-Yi Lei, Jian-Yu Lee, Chie-Lin Chen, Ming-Jong Bair, Jeng-Yih Wu, Deng-Chyang Wu, Hui-Wen Tien, Li-Ju Lin, Tsui-Hsia Hsuttt, Yi-Chia Lee
Journal: The Lancet Oncology (2022)
One hundred most cited article related to pancreaticoduodenectomy surgery: A bibliometric analysis
Authors: Ruizhi He, Taoyuan Yin, Shutao Pan, Min Wang, Hang Zhang, Renyi Qin
Journal: International Journal of Surgery (2022)

In light of the challenges associated with pancreaticoduodenectomy (PD) and recent key improvements, this bibliometric analysis aimed to analyze the 100 top-cited (T100) articles related to PD surgery to widen the awareness of relevant research on this procedure.The term "pancreaticoduodenectomy" was used to retrieve articles from the Web of Science Core Collection database. The 100 most cited manuscripts in the English language were identified and further analyzed by their countries of origin, publication journals, authors, and themes.A thorough literature search was performed on the Web of Science until April 2020. The total number of citations for the T100 articles ranged from 227 to 3029. The T100 articles came from 18 different countries, with the USA accounting for the plurality (n = 72). Professor J.L. Cameron from Johns Hopkins Medicine USA published the most articles (n = 22), including one as the first author and two as a co-author. Furthermore, Johns Hopkins Medicine, USA, published the most articles on PD surgery (n = 24), with a total citation count of 14,151. The journal Annals of Surgery published 40 of the T100 articles, with 15,847 citations and an average citation count of 396. Among the T100 articles, the citation frequency following the year of publication showed a parabolic trend, with citations peaking in the 9th year following publication.Our study identified and analyzed the T100 articles in PD surgery. The USA was the dominant country regarding articles, researchers, and institutions. The citations of the articles peaked in the 9th year after publication.
Early Ultrasound Response and Progressive Transmural Remission After Treatment With Ustekinumab in Crohn’s Disease
Authors: Torsten Kucharzik, Rune Wilkens, Maria-Antonietta D’Agostino, Giovanni Maconi, Manuela Le Bars, Marjolein Lahaye, Ivana Bravatà, Maciej Nazar, Lioudmila Ni, Elena Ercole, Mariangela Allocca, Naděžda Machková, Floris A.E. de Voogd, Carolina Palmela, Rose Vaughan, Christian Maaser, Tomas Grega, Ivana Niangova, Rudolf Repak, Petra Matejkova, Radka Vanickova, Juel Mie Agerbæk, Annett Cannon, Vittorio Giuliano, Christoph Antoni, Jürgen Büning, Michael Gebel, Martin Grewe, Sebastian Küpper, Nikolas Ryschka, Andrej Potthoff, Wolfgang Reindl, Karolin Schliwa, Martin Schulz, Hermann Schulze, Markus Krankenhaus, Marco Affronti, Maria Laura, Christina Bezzio, Flaminia Cavallaro, Marina Coletta, Andrea Costantino, Federico Furfaro, Fabrizio Pizzolante, Steven Bots, Robert De Knegt, Ivan Bunganic, Zdenek Opravil, Joaquin Poza, Jordi Rimola, Cristina Suarez Ferrer
Journal: Clinical Gastroenterology and Hepatology (2022)

In this STARDUST substudy, the effect of ustekinumab on transmural bowel inflammation was assessed in adults with moderate-to-severe Crohn's disease (CD) by using intestinal ultrasound (IUS), a noninvasive imaging procedure.STARDUST was an international, multicenter, phase 3b, interventional, randomized controlled trial specifically designed to compare treat-to-target and standard-of-care treatment strategies in ustekinumab-treated CD patients. In this substudy, the most affected bowel segment at baseline by IUS was used for all analyses. Key IUS endpoints (centrally read, parameter-blinded) were IUS response, transmural remission, bowel wall thickness (BWT), blood flow, bowel wall stratification, and inflammatory fat.Seventy-seven patients were evaluated. IUS response could be determined 4 weeks after treatment initiation, with progressive improvement through week 48. IUS response and transmural remission rates at week 48 were 46.3% and 24.1%, respectively. IUS response, transmural remission, BWT, and blood flow normalization rates were more pronounced in the colon and biologic-naive patients. Fair/moderate reliability (κ = 0.21-0.51) was observed between week 4 IUS response and week 48 overall endoscopic response and fecal calprotectin/complete biomarker outcomes. Endoscopy and IUS baseline agreement was >90% in determining the terminal ileum as the most affected bowel segment. IUS response absence at week 4 was associated with no endoscopic response (based on the simplified endoscopic score for Crohn's disease terminal ileum subscore) at week 48 (negative predictive value = 73%).In this first international, multicenter, interventional study, IUS showed that ustekinumab-treated CD patients achieved progressive IUS response (46.3%) and transmural remission (24.1%) through week 48, with a more robust response in the colon and biologic-naive patients.gov number: NCT03107793.
Epidemiology and outcomes of acute promyelocytic leukaemia in the era of all-trans retinoic acid (ATRA) chemotherapy and arsenic trioxide plus ATRA: a retrospective analysis
Authors: Harinder Gill, Radha Raghupathy, Michael Ni, Xiao Xiao, Francis Flores, Carmen Lee, Rita Yim, Paul Lee, Cyrus Kumana, Yok-Lam Kwong
Journal: The Lancet Oncology (2022)
Impact of integrated palliative care in acute and aggressive medical care for patients with advanced haematological malignancies: a retrospective matched case-control study
Authors: Kwok Ying Chan, Harinder Singh Harry Gill, Thomas Sau Yan Chan, Cho Wing Li, Kwok Wai Tsang, Ho Yan Au, Chi Yan Wong, Chun Him Hui, Lesley Wan Sze Mok
Journal: The Lancet Oncology (2022)
Tumour response heterogeneity as a powerful independent predictor of treatment outcome in advanced lung adenocarcinoma: a retrospective analysis
Authors: Xinlong Zheng, Tao Lu, Shiwen Wu, Wenying Peng, Qian Miao, Kan Jiang, Longfeng Zhang, Xiaobing Zheng, Yiquan Xu, Gen Lin
Journal: The Lancet Oncology (2022)
Improving hydroxyapatite coating ability on biodegradable metal through laser-induced hydrothermal coating in liquid precursor: Application in orthopedic implants
Authors: Jaeho Park, Seung-Hoon Um, Youngmin Seo, Jaehong Lee, Yu-Chan Kim, Myoung-Ryul Ok, Suk-Won Hwang, Jeong-Yun Sun, Hyung-Seop Han, Hojeong Jeon
Journal: Bioactive Materials (2022)

During the past decade, there has been extensive research toward the possibility of exploring magnesium and its alloys as biocompatible and biodegradable materials for implantable applications. Its practical medical application, however, has been limited to specific areas owing to rapid corrosion in the initial stage and the consequent complications. Surface coatings can significantly reduce the initial corrosion of Mg alloys, and several studies have been carried out to improve the adhesion strength of the coating to the surfaces of the alloys. The composition of hydroxyapatite (HAp) is very similar to that of bone tissue; it is one of the most commonly used coating materials for bone-related implants owing to favorable osseointegration post-implantation. In this study, HAp was coated on Mg using nanosecond laser coating, combining the advantages of chemical and physical treatments. Photothermal heat generated in the liquid precursor by the laser improved the adhesion of the coating through the precipitation and growth of HAp at the localized nanosecond laser focal area and increased the corrosion resistance and cell adhesion of Mg. The physical, crystallographic, and chemical bondings were analyzed to explore the mechanism through which the surface adhesion between Mg and the HAp coating layer increased. The applicability of the coating to Mg screws used for clinical devices and improvement in its corrosion property were confirmed. The liquid environment-based laser surface coating technique offers a simple and quick process that does not require any chemical ligands, and therefore, overcomes a potential obstacle in its clinical use.
Designing Your Ambulatory Endoscopy Center: Lessons from Accreditation
Authors: Deborah Edelman, Noel Adachi, Frank J. Chapman, Lawrence S. Kim
Journal: Clinical Gastroenterology and Hepatology (2022)

Endoscopy-specific ambulatory surgery centers (ambulatory endoscopy center [AEC]) are the dominant site of service for independent community-based and academic gastroenterology practices in the United States. For most gastroenterologists, constructing a new AEC is the most complex and capital-intensive project that they will encounter in their careers. Much has been written about AEC design, primarily with regard to maximizing functionality and efficient throughput.1,2 However, regulatory considerations are another critical factor, because new AECs require certification to provide care to Medicare recipients and external accreditation as required by state and local jurisdictions or private payers.